PATIOPERMIT APPLICATION FOR MUNICIPALITIES OF DADE COUNTY
(OWNER TO RETAIN COPY)
Date PeZ/65 -Job Address �!� , �If Tax Folio /J3 40P/
Legal Description 1-0r 3 �' / /�� 3 A2 2 RAT OF 141/4 5 f`fo>~'b`� S.EG l
er Lessee / Tenant C= i 4 Master Permit #
-Pg. to /7e)
Owner's Address Z7‘ y(IE 9 I !f k' ( 0v4�E� '�"�- Phone75 7 - G
Contracting Co. SiEtv F Address
Qualifier SS# - - Phone
State # Municipal # Competency # Ins.Co.
Address
Bonding Company Address
Mortgagor r Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIG/
WORK DESCRIPTION I'G ( FA-no SToN k5S IA) 17 ()/U ".7(,V &&b
Square Ft. low �r
Architect /Engineer
Notary as to Owner and /or Condo President
My Commission Expires:
Mechanical Plumbing
Estimated Cost(value) 4
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DC
SO MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTENI
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOU'
NOTICE OF COMMENCEMENT).
Application is hereby made to obtain a permit to do work and installation as indicated above, an
on the attached addendum (if applicable). I certify that all work will be performed to meet th
standards of all laws regulating construction in this jurisdiction. I understand that separate
permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work wil'
be done in compliance with all applicable laws regulating construction and zoning. Furthermore,
authorize the above -named contractor to do the work stated.
Signature of owner and /or Condo President Signat re of Obwftmeetemmac Owner- Builder
Date: te: Xi( a () -
( 1/FA.0-YuL ,geo
Notary as to iikoTticreeemaght Owner- Builder
My Commission Expires :Ye tm rcc, ,4-641(f
NOTARY PUBLIC STATE OF FLORIDA
MY COMMISSION EXPIRES 5/09/94
* * * @ended Ora StembleiAdanis *Sweet **
** * * * * * * * *
FEES: PERMIT 31 RADON C.C.F.
APPROVED: Fire
Zoning Building �i,� Electrical
r NOTARY . 5( 0 6
TOTAL DUE e'aa
Other
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LOCATED IN : // n/
D,� �� COUNTY, FLORIDA